Elevated platelet microparticle levels after acute ischemic stroke with concurrent idiopathic thrombocytopenic purpura

Masahiko Ichijo; Satoru Ishibashi; Takuya Ohkubo; Shosaku Nomura; Nobuo Sanjo; Takanori Yokota; Hidehiro Mizusawa

doi:10.1016/j.jstrokecerebrovasdis.2013.04.032

Elevated platelet microparticle levels after acute ischemic stroke with concurrent idiopathic thrombocytopenic purpura

J Stroke Cerebrovasc Dis. 2014 Mar;23(3):587-9. doi: 10.1016/j.jstrokecerebrovasdis.2013.04.032. Epub 2013 Jun 6.

Authors

Masahiko Ichijo¹, Satoru Ishibashi¹, Takuya Ohkubo¹, Shosaku Nomura², Nobuo Sanjo¹, Takanori Yokota¹, Hidehiro Mizusawa³

Affiliations

¹ Department of Neurology and Neurological Science, Tokyo Medical and Dental University, Tokyo, Japan.
² First Department of Internal Medicine, Kansai Medical University, Osaka, Japan.
³ Department of Neurology and Neurological Science, Tokyo Medical and Dental University, Tokyo, Japan. Electronic address: [email protected].

PMID: 23747179
DOI: 10.1016/j.jstrokecerebrovasdis.2013.04.032

Abstract

We report a 60-year-old woman with idiopathic thrombocytopenic purpura who experienced acute infarction of the middle cerebral artery. She was treated with an antiplatelet agent and prednisolone to limit platelet activation and destruction. In parallel with clinical amelioration, levels of plasma platelet microparticles (PMPs), a procoagulant factor in platelet activation, decreased after treatment but increased after reduction of the prednisolone dose, resulting in progression of vascular stenosis. Immunosuppressive therapy with cyclosporine normalized plasma PMP levels, and no additional vascular events occurred during the 3-month follow-up period. Immunosuppressive therapy to decrease plasma PMP levels is warranted after acute ischemic stroke in the context of idiopathic thrombocytopenic purpura.

Keywords: Idiopathic thrombocytopenic purpura; ischemic stroke; platelet microparticles.

Publication types

Case Reports

MeSH terms

Blood Platelets / drug effects
Blood Platelets / pathology*
Cell-Derived Microparticles / drug effects*
Cell-Derived Microparticles / pathology
Cerebral Angiography / methods
Cilostazol
Cyclosporine / therapeutic use
Dexamethasone / therapeutic use
Diffusion Magnetic Resonance Imaging
Female
Glucocorticoids / therapeutic use
Humans
Immunosuppressive Agents / therapeutic use
Infarction, Middle Cerebral Artery / blood
Infarction, Middle Cerebral Artery / complications*
Infarction, Middle Cerebral Artery / diagnosis
Infarction, Middle Cerebral Artery / drug therapy
Magnetic Resonance Angiography
Middle Aged
Platelet Aggregation Inhibitors / therapeutic use
Prednisolone / therapeutic use
Purpura, Thrombocytopenic, Idiopathic / blood
Purpura, Thrombocytopenic, Idiopathic / complications*
Purpura, Thrombocytopenic, Idiopathic / diagnosis
Purpura, Thrombocytopenic, Idiopathic / drug therapy
Tetrazoles / therapeutic use
Time Factors
Tomography, X-Ray Computed
Treatment Outcome
Up-Regulation

Substances

Glucocorticoids
Immunosuppressive Agents
Platelet Aggregation Inhibitors
Tetrazoles
Dexamethasone
Cyclosporine
Prednisolone
Cilostazol